SNRIs
Cymbalta for lower back pain
Cymbalta (duloxetine) will be used more for chronic musculoskeletal pain in the lower back or due to osteoarthritis . Cymbalta is already approved for neuropathic pain . Plus, it's approved for chronic musculoskeletal pain, so physicians are hearing more about this use, too. Some antidepressants do have analgesic effects, especially tricyclics (amitriptyline, …
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Pain Management
Consider kidney risks before using an NSAID
As a hospital pharmacist, you will be asked more, which NSAID is preferred in patients with kidney disease?.. There is NOT a “safest” NSAID for the kidneys . You might’ve heard that short-acting NSAIDs (ibuprofen, etc) are least kidney toxic. But this isn’t supported by evidence. The real key is to use the lowest NSAID dose for the s…
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SNRIs
Compare medications for DIABETIC Neuropathy
Up to 50% of patients with diabetes develop peripheral neuropathy. Tailor medication selection based on side effects, cost, whether the medication can also treat other conditions, etc. Expect trial and error... Start at low doses and titrate to effect. But set realistic expectations. In general, fewer than 1 in 3 patients will see a 50% decrease in pain with first-l…
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Pain Management
Consider the interaction between aspirin and NSAIDs
New data and talk of OTC label changes will reignite debate about whether NSAIDs reduce the cardiovascular (CV) protective effect of aspirin .. Many of us remember when FDA warned that ibuprofen may interact with aspirin . This is because aspirin binds to COX-1 to inhibit platelet aggregation and nonselective NSAIDs can compete for the same receptor. OTC ibuprofen…
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Pain Management
Is it okay for HYPERtensive patients to take NSAIDs?
Is it okay for patients with hypertension to take NSAIDs e.g., ibuprofen, celecoxib, etc? ― Many can, but you need to be careful... On average, NSAIDs increase blood pressure (BP) by around 5 mmHg in patients with hypertension, but some patients are more susceptible than others. Elevations are more likely in the elderly, obese men and patients with diabetes ,…
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Pain Management
Bruxism (tooth grinding)
Background ㅡ Bruxism is nonfunctional jaw movement that includes clenching, grinding, clicking, and gnashing of the teeth, most commonly occurring during sleep. Prevalence in adults is 8%. Roughly 3% of patients do not resolve completely. Bruxism is classified into primary (idiopathic) or secondary (iatrogenic). Some of the common secondary causes seen in clinical …
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Pain Management
IV lidocaine is an anti-arrhythmic and also can be for pain too
As a hospital pharmacist, you will see intravenous lidocaine used to treat pain. IV lidocaine can help stop heart arrhythmias. But it also has some analgesic and anti-inflammatory effects. Expect to see lidocaine 1.5 mg/kg bolus doses for pain due to conditions such as headache, kidney stones, or trauma when other analgesics don&#…
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Sumatriptan
Acute and prophylactic medications to manage CLUSTER headaches
Patients will need your help managing CLUSTER HEADACHES. They're called "suicide headaches" because the pain is so severe. Cluster headaches almost always occur on one side of the face by the eye and cause tearing, runny or stuffy nose, and restlessness. Attacks don't last as long as a migraine. But they usually occur in clusters of weeks to months,…
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Pain Management
Management of pain in patients with renal insufficiency or end-stage renal disease on dialysis
Overview ㅡ Pain is a common problem in patients with renal insufficiency and end-stage renal disease (ESRD) and can have a significant effect on the patient’s quality of life. When assessing a patient’s pain, assess both the severity of the pain (such as on an analogue scale, 0-10) and the characteristics of the pain ( see figure 1 ). Pain is most commonly characte…
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Pregnancy and Breastfeeding
Analgesics during pregnancy and lactation
Analgesics during pregnancy ㅡ Acetaminophen ( Panadol, Novaldol ) is analgesic drug of choice for pain during pregnancy (Pregnancy category B). See, figure-1-FDA pregnancy categories prior to 2014 . Figure (1) FDA pregnancy categories. Non-steroidal anti-inflammatory drugs (NSAIDs) …
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Rheumatology
Allopurinol or febuxostat for chronic gout?
As a pharmacist, you’ll get questions about managing chronic gout due to continued debate over whether to aim for a target uric acid level. We know to consider a chronic medication to lower uric acid when gout causes problems such as tophi or 2 or more acute gout flares/year. But there’s not much evidence on the best way to titrate medications. Some “treat to target”…
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Rheumatology
The latest recommendations for treating osteoarthritis
As a clinical pharmacist, it's essential to emphasize that exercise (such as walking and strengthening exercises) and weight loss, if needed, remain the main approaches for management. It's important to note that while oral NSAIDs like naproxen are often effective, they may not be suitable for everyone due to potential risks to the heart, stomach, and kidney…
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Pain Management
Kidney risks of non-steroidal anti-inflammatory drugs (NSAIDs)
As a pharmacist, you will see more focus on the kidney risks of non-steroidal anti-inflammatory drugs (NSAIDs). Some government and medical groups are now educating providers to avoid giving NSAIDs to patients at risk for kidney problems. Think about a patient's risk before suggesting an NSAID. It's usually okay for patients with …
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Pain Management
Treating dental pain (tooth pain or toothache)
OVERVIEW ㅡ A toothache or tooth pain is caused when the nerve in the root of a tooth or surrounding a tooth is irritated. Dental (tooth) infection, decay, injury, or loss of a tooth are the most common causes of dental pain. Pain may also occur after an extraction (tooth is pulled out). Pain sometimes originates from other areas and radiates to the jaw, thus appeari…
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